Provider Demographics
NPI:1730438771
Name:NEUROLOGICAL GROUP OF SOUTH FLORIDA INC.
Entity type:Organization
Organization Name:NEUROLOGICAL GROUP OF SOUTH FLORIDA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-994-3393
Mailing Address - Street 1:7700 CONGRESS AVE
Mailing Address - Street 2:SUITE 1115
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1352
Mailing Address - Country:US
Mailing Address - Phone:561-994-3393
Mailing Address - Fax:561-994-3395
Practice Address - Street 1:7700 CONGRESS AVE
Practice Address - Street 2:SUITE 1115
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1352
Practice Address - Country:US
Practice Address - Phone:561-994-3393
Practice Address - Fax:561-994-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty